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Injury factors associated with discharge status from emergency room at two major trauma hospitals in The Gambia, Africa
Abstract
Introduction:
Injuries are the leading cause of disability across all ages and gender. In this study, we identified predictors of discharge status and disability at discharge among patients who seek emergency room treatment.
Materials and methods:
The study was conducted in two major trauma hospitals in urban Gambia. 1905 patients participated in the study. 74.9% were males, and 25.1% were females. The study includes injured patients from all mechanisms. However, patients' records without age, gender, injury mechanism, and deposition from the emergency room were considered incomplete and excluded. We examined distributions of injury by age, gender, mechanism, place of occurrence, intent, primary body part injured, and primary nature of injury. We identified demographic and injury characteristics associated with hospital admission (compared to emergency department discharge) and discharge disability (any level of disability compared with none).
Results:
The leading mechanisms of injury were road traffic (26.1%), struck by objects (22.1%), cut/pierce (19.2%), falls (19.2%), and burns (5.4%). Injuries most commonly occurred in the home (36.7%) and on the road (33.2%). For those aged 19-44, the proportion of injuries due to assault was higher for females (35.9%) than males (29.7%). Males had increased odds for admission (aOR=1.48 95% CI=1.15-1.91) and for disability (aOR=1.45; 95% CI=1.06-1.99). Increased odds for admission were found for brain injuries, fractures, large system injuries, and musculoskeletal injuries when compared with soft tissue injuries. The highest odds for any level of discharge disability were found for brain injuries, fractures, injuries from falls, burns, and road traffic.
Conclusions:
Epidemiology of injuries in The Gambia is similar to other low-income countries. However, the magnitude of cases and issues uncovered highlights the need for a formal registry.
... As in other LMICs, there is limited information on road traffic-related morbidity and mortality for The Gambia (West Africa) and Tanzania (East Africa). Part of the valuable information in the literature that documents the nature and mechanism of injuries as presented in emergency rooms are data from the trauma registries initiated in The Gambia and Tanzania (Sanyang, Peek-Asa, Bass, Young, Jagne, et al., 2017;Sawe Reynolds, Weber, Mfinanga, Coats & Wallis, 2020). Sanyang, Peek-Asa, Bass, Young, Jagne, et al. (2017) found that one in every three admitted patients were road traffic injury (RTI) victims in The Gambia. ...
... Part of the valuable information in the literature that documents the nature and mechanism of injuries as presented in emergency rooms are data from the trauma registries initiated in The Gambia and Tanzania (Sanyang, Peek-Asa, Bass, Young, Jagne, et al., 2017;Sawe Reynolds, Weber, Mfinanga, Coats & Wallis, 2020). Sanyang, Peek-Asa, Bass, Young, Jagne, et al. (2017) found that one in every three admitted patients were road traffic injury (RTI) victims in The Gambia. More than one-third of admitted road traffic victims are students, with a mean age of 14 years, who are mostly pedestrians. ...
Road traffic injury is the seventh leading cause of death in low-income countries, the tenth leading cause of death in resource-limited countries for all ages, and the leading cause of death for adolescents and youths worldwide. In this study, we seek to provide information on youths’ perceptions of risky road traffic safety behaviours. A self-administered survey on youths’ risk perceptions of road traffic crashes in The Gambia and Tanzania was distributed to students at universities in The Gambia and at the Muhimbili University of Health and Allied Sciences in Tanzania. Risky behaviours and distractions were identified as the primary risk of crashes involving youths. Texting while driving (The Gambia 56.6%, Tanzania 83.7%, AOR = 1.72, 95% CI = 0.5, 5.88) or riding in cars whose drivers had been drinking alcohol (The Gambia 20.2%, Tanzania 59.7%, AOR = 3.12, 95% CI = 1.17, 8.36) were major concerns. These results indicate that the implementation of interventions to reduce driver distractions and impairment are needed in both countries. Prevention efforts should focus on not only roadway designs and vehicle factors, but also on the traffic safety culture and education of road users, especially the youth and young adults. These results fill a knowledge gap that will be beneficial to developing effective interventions to promote a traffic safety culture among youths.
... Two Study conduct in Gambia shows the most common cause of in injury due to assault , illiterate and RTAs significantly associated factors (16,19). ...
... Facility-based prospective cross-sectional study conducted emergency department of Yirgalem General Hospital, Southern Ethiopia reports that prevalence of injury is (49.4%) and distribution of severity of injury, majority of patients (56.7%), had a minor or superficial injury (25.7%) had a moderate injury and (9.3%) had severe type of injury(14) .Similar study conducted in Wolaita Sodo Teaching and Referral Hospital indicate that minor injure was more prevalent when compared to other majority of injury which had minor (45.3%), moderate (40%) and severe injury (14.7%) , respectively (3).Others study conduct Emergency Department at Tikur Anbessa Specialized Referral Hospital, Addis Ababa, Ethiopia report that the prevalence of injury is 32.5% and distribution of severity of injury 71% , had moderate injury 14.6% and 10.6% had severe injury(15) .Different socio-demographic factors are significantly associated with the severity of injury at the time of emergency hospital visit. For example, male sex, productive age group, rural residency and place of referral.A retrospective cohort study conducted in the emergency department of a tertiary care hospital in South India revealed that injury is more prevalence in male sex and age group of 41-60, (5) .Other institutional cross-sectional study done in Gambia Accident and Emergency Units in Edward Francis Small Teaching Hospital and Serrekunda General Hospital injury distribution most prevalent in male gender and age grope of under 40 and low income has significantly associated with injury(16) . Review and Meta-Analysis study of Work-Related Injury and Its Determinants among Construction Workers in Ethiopia and Multiple community-based follow-up survey study conducted in sub-Saharan Africa rebled that lack of knowledge, ...
Severity of injury and associated Factors among the surgical,
Emergency patient at university of Gondar compressive
specialized Hospital, Ethiopia from September 12020 to
September 1, 2021.
... This is in contrast to a body of existing literature that demonstrates males are generally more likely than females to present to emergency departments for traumatic injury. [86][87][88][89][90][91][92][93][94][95] Detailed etiologies of traumatic surgical complaints were not available in hospital records; however, understanding the nature of trauma may represent a potential future area of study, and an important point of intervention for female patients presenting to the ED with trauma. While we are unable to conclude what is causing the observed phenomena in our study population, we are concerned that previous studies have demonstrated that women may suffer a greater proportion of sexual violence and assault injuries compared to male counterparts. ...
... While we are unable to conclude what is causing the observed phenomena in our study population, we are concerned that previous studies have demonstrated that women may suffer a greater proportion of sexual violence and assault injuries compared to male counterparts. 93,96 Domestic violence against women is well documented in Guatemala, and may be one factor that has contributed to the trend observed in our study. [97][98][99] Future research should explore this potential in a culturally sensitive manner. ...
Functioning healthcare systems provide emergency medical care. Disparities exist in accessibility and availability of emergency care in low- and middle-income countries. We present a descriptive epidemiologic analysis of Emergency Department (ED) usage in a rural, indigenous Guatemalan population. San Lucas Tolimán is situated in central Guatemala. Hospital Parroquial de San Lucas offers emergency care to San Lucas Tolimán and surrounding villages. All ED visits between January 1st, 2016 and December 31st 2018 were recorded and analyzed. During the study period, 12,229 patient encounters occurred. Almost all patients identified as indigenous. Children comprised 43% of visits. Medical issues represented a majority (83%) of complaints. Respiratory (40%) and gastrointestinal disease (26%) were frequent presenting complaints. Almost all visits (83%) occurred during the day and evening hours. Trauma/surgical complaints were slightly more frequent at night. 93% of patients were discharged, while the rest were admitted or transferred. These data contribute to understanding of disease burden and emergency care needs and capacity in rural areas of low- and middle-income countries. This information may be used to inform local policy decisions, identify research priorities, and create training topics for local health care providers in Guatemala and other countries in this region.
... The results align with previous research [39] [40][41][42][43], demonstrating a higher incidence of falls among women, particularly those admitted to the geriatric medicine department for chronic conditions such as dementia and strokes. Hip fractures emerged as the most frequent injury following a fall, consistent with prior research [44]. ...
Introduction
Falls represent a significant public health concern affecting the elderly, yet epidemiological studies within Lebanese institutions are scarce. This study aimed to explore gender differences in falls and mobility patterns and assess causes, potential risks, and protective factors against falls among institutionalized elderly in the Chouf district, Lebanon.
Methods
This cross-sectional pilot study involved an elderly healthcare institution. Data were collected using an anonymous, custom-designed questionnaire and patient medical records. Fall risk was evaluated with the Tinetti Balance and Gait Assessment, the Timed Up and Go Test, the Morse Fall Assessment, and other tools. Relative risks were estimated using odds ratios (OR), and logistic regression was stratified by gender to control confounders and assess the associations between fall episodes and potential risk and protective factors.
Results
This study included 300 institutionalized elderly aged 65 years and older, with 57.7% females. The mean age was 79.27 ± 7.61. Among the participants, 197 (65.7%) reported at least one fall in the past twelve months, with a higher prevalence among women compared to men (69.9% vs. 59.8%). Elderly women exhibited higher levels of depression and consumed more sleeping pills and mood-enhancing medications, which were positively associated with increased falls (p = 0.003). Among elderly men, unsteady walking was positively associated with the history of falls (p = 0.004).
Conclusion
This study found a higher incidence of falls among institutionalized women, possibly associated with the intake of sleeping pills and mood stabilizers. These findings have positive implications for future research in Lebanon and neighboring countries, with the potential to inform preventive measures to reduce falls among the elderly.
... A study in Gambia at two major trauma centers found that elderly patients who fall and have brain injuries have the highest odds for disability at the time of discharge. (26) Another study of injury-related mortality in Sub-Saharan Africa found patients who suffered head trauma from falls were more likely to die as a result of their injury. (18) The majority of data about fall-related mortality comes from studies in HICs. ...
... Traumatic injury is the leading cause of emergency department (ED) visits, hospital admission, temporary or permanent disability, and death [1]. Motor vehicle accident (MVA) is one of the significant causes of injury-related deaths accounting for more than 80% of all trauma admissions in Saudi Arabia [2]. ...
Introduction
Abdominal evisceration is uncommon after blunt abdominal trauma; therefore, it warrants urgent laparotomy.
We report a young adult male who sustained multiple injuries due to a high impact mechanism resulting in blunt abdominal injury and underwent numerous laparotomies.
Case report
In a high-speed motorcycle accident, a twenty-six-year-old male sustained a direct, blunt injury to his abdomen, which resulted in a right hemothorax, perforation of the stomach, and small bowel. Multiple mesenteric vessels tear, a retroperitoneal hematoma, liver, and pancreatic injury. The abdominal wall split transversely, extruding intact bowel. After resuscitation, according to the ATLS protocol, the patient underwent eight laparotomies for damage control. After 45 days in the Surgical Intensive Care Unit, then 11 days in the surgical ward, he was discharged in a satisfactory condition. Eight months later, he was admitted electively for ileostomy reversal, which was uneventful.
Conclusion
Patients with high trauma mechanisms have high mortality and morbidity rate. Blunt injury with eviscerated abdominal contents requires prompt, expeditious, and timely intervention, particularly at the initial operative intervention with damage control procedures, both prompt management and structured approach, were tailored depending in the magnitude of the injury. A multidisciplinary approach is mandatory throughout the period of treatment until recovery and rehabilitation.
... Injuries account for 9% of the world's deaths, aside which, many injured patients are left with temporary or permanent disabilities [1]. Approximately half of injury-related deaths occur in individuals aged 15-44 years, and this is during their most economically productive years, making the burden of injuries exceed by far, the associated perceived immediate medical costs [2]. ...
Introduction
Injuries remain a leading cause of death in many developing countries, accounting for more deaths than HIV, tuberculosis, and malaria combined. This study set out to determine the associated patient costs of reported injury cases at the Accident and Emergency Department of the Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana.
Method
A cross-sectional retrospective Cost-of-Illness study of 301 sampled patients was undertaken, following a review of injured patients' records from January–December 2016. Direct cost, (consisting of consultation, surgery, medicines, transportation, property damage, food and consumables) was estimated. Indirect cost was calculated using the Human capital approach. Intangible cost was assessed using Likert scale analysis. The overall household cost, average cost of various injuries and intangible costs were determined.
Results
The total annual household cost of injuries to patients who attended KBTH was US 1276.15. All injuries recorded some level of high intangible cost but was exceptional for burns.
Conclusion
Injured patients incur high direct treatment cost in all aetiology, with generally high intangible cost as well. It is therefore imperative that injury prevention strategies be prioritized in national health policies, while broader discussions continue on sustainable health financing of injury management.
... While the epidemiology of chronic leg ulcers in sub-Saharan Africa has not been well characterized, studies from other regions indicate that leg ulcers are relatively common, with 60% of leg ulcers being present for more than 6 months and one-third persisting for over 1 year [1]. Based on the high burden of traumatic soft tissue injuries reported from multiple countries in sub-Saharan Africa [2][3][4][5], traumatic injury likely contributes to a large proportion of chronic leg ulcers seen in this region of the world. Similarly, lymphedema from primary or secondary etiologies causes progressive functional impairment marked by swelling, physical discomfort, disfiguring changes, skin hardening from fibrosis, poor wound healing, recurrent skin infection, and rarely tumors [6]. ...
Introduction:
Compression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities. When wound care providers from an Academic Model Providing Access to Healthcare (AMPATH) health center in Western Kenya noted that a donated, finite supply of two-component compression bandages was helping to heal chronic leg ulcers, they began to explore the potential of finding a local, sustainable solution. Dermatology and pharmacy teams from AMPATH collaborated with health center providers to address this need.
Methods:
Following a literature review and examination of ingredients in prepackaged brand-name kits, essential components were identified: elastic crepe, gauze, and zinc oxide paste. All of these materials are locally available and routinely used for wound care. Two-component compression bandages were made by applying zinc oxide to dry gauze for the inner layer and using elastic crepe as the outer layer. Feedback from wound clinic providers was utilized to optimize the compression bandages for ease of use.
Results:
Adjustments to assembly of the paste bandage included use of zinc oxide paste instead of zinc oxide ointment for easier gauze impregnation and cutting the inner layer gauze in half lengthwise to facilitate easier bandaging of the leg, such that there were two rolls of zinc-impregnated gauze each measuring 5 inches × 2 m. Adjustments to use of the compression bandage have included increasing the frequency of bandage changes from 7 to 3 days during the rainy seasons, when it is difficult to keep the bandage dry. Continuous local acquisition of all components led to lower price quotes for bulk materials, driving down the production cost and enabling a cost to the patient of 200 KSh (2 USD) per two-component compression bandage kit. Wound care providers have provided anecdotal reports of healed chronic leg ulcers (from venous stasis, trauma), improved lymphedema, and patient tolerance of compression.
Conclusions:
Low-cost locally sourced two-component compression bandages have been developed for use in Western Kenya. Their use has been initiated at an AMPATH health center and is poised to meet the need for affordable compression therapy options in Western Kenya. Studies evaluating their efficacy in chronic leg ulcers and Kaposi sarcoma lymphedema are ongoing. Future work should address adaptation of compression bandages for optimal use in Western Kenya and evaluate reproducibility of these bandages in similar settings, as well as consider home- or community-based care delivery models to mitigate transportation costs associated with accessing healthcare facilities.
Emergency Medical Systems differ around the world and perform at varying levels of effectiveness. This study analyzed how well countries met the emergency response requirements for emergency medical teams set by the World Health Organization and professional literature recommendations in the three levels of country classifications set by the United Nations. This was conducted through a stratified random sample of ten countries in the categories: developed, economies in transition, and developing, for a total of thirty countries. Each country was qualitatively analyzed for emergency response times, types of public-to-provider communication, insurance/financial coverage, certification level of emergency care provider, and level of emergency hospital care. These areas were compared to the WHO recommendations and the higher standards of care recommended by the professional literature. It was found that 90% of developing countries did not meet the WHO recommendation compared to 50% of transitioning economies, and 10% of developed countries. There was a strong positive correlation between Gross Domestic Product and overall effectiveness of an EMS system. Moving forward, it is recommended that the underlying problems be identified, risk factors evaluated, possible interventions created, and implementing interventions in developing countries to improve communication from public to provider in pre-hospital care, and hospital emergency care
Objectives
Emergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators.
Design
We conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature.
Data sources
PubMed (1964—2 January 2022), Embase (1947—2 January 2022) and CINAHL (1982—3 January 2022) and various forms of grey literature were queried.
Eligibility criteria
Studies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as ‘AFEM-CC quality indicators near match’.
Data extraction and synthesis
Document screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated.
Results
One thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 ‘AFEM-CC quality indicators near match’ publications were identified (38 new publications and 15 previously identified studies that contained additional ‘near match’ data), yielding 87 data points.
Conclusions
Data relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
Background:
Trauma is a worldwide problem that results in significant morbidity and mortality in developing countries.
Objective:
This study looks at the demography of trauma from data abstracted from a Nigerian trauma registry and considers the peculiarities of a low-resource setting from this perspective.
Methods:
Trauma registry data from January 2013 to June 2014 were analyzed.
Results:
A total of 542 patients were included in the study. The mean age of the patients was 33.43 ± 12.79 years; the median time from injury to arrival at the hospital was 3 h (interquartile range IQR 1 - 5.1 h); three-quarters of the patients sustained their injuries on the road-tricycles were rarely involved in road traffic injuries (RTIs) (6.9% of RTIs) but were used in transporting a third of the patients whose data on means of transportation were captured. There were 15 (2.7%) deaths in the first 24 h period postinjury covered by the study - 13 (86.7%) of these patients had head-and-neck injury. About half of the assault injury (50.5%) was from persons known to the victim. The shock indices suggested that a majority of the patients were not at a high risk of mortality.
Conclusion:
Most of the trauma patients at our hospital were in low- to middle-income categories. The median time to arrival of injured patients was 3 h (IQR 1 - 6 h). Most injuries occurred on the road because of RTIs. The involvement of tricycles in accidents was uncommon, but they were used fairly commonly by lay responders in transporting the injured victim to hospital. A high proportion of assailants were known to the victim. The use of trauma registries provides essential data for prioritizing limited resources and can guide a contextualized approach to reducing trauma and improving trauma patient care.
In Western Kenya, the burden of chronic wounds and lymphedema has a significant impact on functionality and quality of life. Major barriers to provision of care include availability, affordability, and accessibility of bandages. At the Academic Model Providing Access to Healthcare, dermatologists and pharmacists collaborated to develop a 2-component compression bandage modeled after the Unna boot, using locally available materials, that is distributed through a revolving fund pharmacy network. In partnership with nursing, use of these bandages at a national referral hospital and a few county facilities has increased, but increasing utilization to an expanded catchment area is needed.
The purpose of the current study was to identify the existing practices and policies on TBI treatment and rehabilitation in the Republic of Moldova.
Methods:
Qualitative face-to-face interviews were conducted with health care professionals from two major emergency hospitals in Chisinau Municipality in 2018. An interview guide was modeled according to a standard operation procedure with a set of concrete questions.
Results:
Participants' underlines important issues in the health care management of TBI for different medical levels: pre-hospital care ambulance system and definitive care work, acute care focused on the existing frameworks for treatment and care of TBI patients in hospitals, rehabilitation care, treatment, prevention gaps, and country-level resources. The main gaps in the prevention and treatment of traumatic injuries were identified to be related to road accidents, alcohol-related injuries, home injuries, and long arriving times of ambulance, lack of medical equipment both at pre-hospital and acute care and low salaries of medical staff.
Conclusion:
Our results suggested the need for health promotion and health education campaigns, police interventions, state support, acquiring financial support and modern equipment.
a b s t r a c t Vulnerable Road Users defined as people at risk in traffic due to absence of an outside protective shield to absorb energy during a collision are mainly pedestrians, bicycle riders and motor cyclists. In low income countries, deaths of VRUs outnumber vehicular drivers and occupants. A forensic pathologist not only reports the cause of death but also forms opinions on type of road user. We attempted to find whether pedestrians could be differentiated from other types of VRUs. A retrospective descriptive study, based on case records of VRUs fatalities from 2005 to 2012 referred to a tertiary care unit for post-mortem ex-amination, was conducted. A pro-forma was developed to extract data from the post-mortem reports and toxicology reports. Data was analysed using SPSS version16. Out of the 328 cases 48% (n ¼ 157) were pedestrians while 45% (n ¼ 147) were riders/pillion riders of two wheeled vehicles and 5% (n ¼ 16) were drivers/occupants of three-wheelers. The majority (87%) was males and 43% of pedestrians were elderly. 59% had 10e25 injuries and 87% had external injuries in the head, face and neck. The majority of skeletal injuries were in the skull followed by ribs. Analysis of different variables of pedestrians to other types of VRUs showed that the variables of, elderly male, road crosser, skull injuries, brain injuries, cause of death being head injuries and multiple injuries were significantly greater among pedestrian group (p: <0.001). The traffic hours (peak and off peak), number of injuries, rib injuries, limb injuries, crushed/run over injuries or lung and liver injuries had no significant association. Although some features helped in determining a pedestrian, many other factors were not associated to differentiate a pedestrian from other VRUs. Therefore, a forensic pathologist has to be cautious in expressing opinions when other corroborative evidence is lacking.
Injury rates in sub-Saharan Africa are among the highest in the world, but prospective, registry-based reports from Cameroon are limited. We aimed to create a prospective trauma registry to expand the data elements collected on injury at a busy tertiary center in Yaoundé Cameroon.
Details of the injury context, presentation, care, cost, and disposition from the emergency department (ED) were gathered over a 6-month period, by trained research assistants using a structured questionnaire. Bivariate and multivariate models were built to explore variable relationships and outcomes.
There were 2,855 injured patients in 6 months, comprising almost half of all ED visits. Mean age was 30 years; 73 % were male. Injury mechanism was road traffic injury in 59 %, fall in 7 %, penetrating trauma in 6 %, and animal bites in 4 %. Of these, 1,974 (69 %) were discharged home, 517 (18 %) taken to the operating room, and 14 (1 %) to the intensive care unit. The body areas most severely injured were pelvis and extremity in 43 %, head in 30 %, chest in 4 %, and abdomen in 3 %. The estimated injury severity score (eISS) was <9 in 60 %, 9-24 in 35 %, and >25 in 2 %. Mortality was 0.7 %. In the multivariate analysis, independent predictors of mortality were eISS ≥9 and Glasgow Coma Score ≤12. Road traffic injury was an independent predictor for the need to have surgery. Trauma registry results were presented to the Ministry of Health in Cameroon, prompting the formation of a National Injury Committee.
Injuries comprise a significant proportion of ED visits and utilization of surgical services in Yaoundé. A prospective approach allows for more extensive information. Thorough data from a prospective trauma registry can be used successfully to advocate for policy towards prevention and treatment of injuries.
Africa has 4% of the global vehicles but accounts for about one tenth of global vehicular deaths. Major trauma in Kenya is associated with excess mortality in comparison with series from trauma centers. The determinants of this mortality have not been completely explored.Objectives: To determine the factors affecting mortality among road users in Nairobi, Kenya.
Cross-sectional study of prospectively collected data of trauma admissions at the Kenyatta National Hospital over a calendar year (2009-2010). Information collected included age, gender, road user type, principal anatomical region of injury, admission status, admission blood pressure and GCS, disposition destination, Injury Severity Score (ISS), injuries sustained, treatment and mortality at two weeks. Major or severe injury was defined as injuries of ISS > 15. Groups based on in-hospital survival were compared using determinants of mortality using X2 or students t-test as appropriate. Logistic regression was used to assess the independence of predictive variables.
One thousand six hundred forty seven (1647) patients were admitted for trauma during the study period. Traffic admissions were 1013 (61.7%) and males predominated (79.8%). The average age of patients admitted was 31.7 years. Pedestrians, vehicle occupants and motorcyclists represented 43.3%, 27.2% and 15.2% of the road users injured. The proportion of patients with ISS > 15 was 10.9%.The overall mortality was 7.7%. Mortality for ISS > 15 was 27.6%. The following factors significantly predicted mortality on univariate analysis: head injury, abdominal injury, transfer in status, blood transfusion, ICU admission, age > 60 years, Glasgow coma scale (GCS) and injury severity. GCS (p = 0.001) and ISS > 15 (p < 0.05) remained significant predictors on regression analysis.
Trauma mortality rates in this study exceed those from mature trauma systems. Head injury and injury severity based on the ISS are independent predictors of mortality after traffic trauma. Improvements in neurosurgical and critical care services ingrained within wider primary and secondary prevention initiatives are logical targets.
Violence and other traumatic events, as well as psychiatric disorders are frequent in developing countries, but there are few population studies to show the actual impact of traumatic events in the psychiatric morbidity in low and middle-income countries (LMIC).
Aims
To study the relationship between traumatic events and prevalence of mental disorders in São Paulo and Rio de Janeiro, Brazil.
Methods
Cross-sectional survey carried out in 2007–2008 with a probabilistic representative sample of 15- to 75-year-old residents in Sao Paulo and Rio de Janeiro, Brazil, using the Composite International Diagnostic Interview.
Results
The sample comprised 3744 interviews. Nearly 90% of participants faced lifetime traumatic events. Lifetime prevalence of any disorders was 44% in Sao Paulo and 42.1% in Rio de Janeiro. One-year estimates were 32.5% and 31.2%. One-year prevalence of traumatic events was higher in Rio de Janeiro than Sao Paulo (35.1 vs. 21.7; p
Intentional injury, including interpersonal violence and self-harm, is one of the world's leading causes of preventable injury. In Europe alone, nearly 1.5 million individuals receive medical treatment each year for a violence-related injury. We examined violent injuries treated in the largest Emergency Department (ED) in Tîrgu Mures County, Romania, with a catchment area of approximately 580 000 residents to describe the epidemiology of assault and self-harm injuries.
Data were collected as part of the European Injury Database project, from a sample of patients who presented with a violence-related injury and received care from the ED of the Mures County Emergency Hospital, Romania. The data were collected for 9 months by two trained emergency physicians. Information about individual demographics; mechanism, nature, place, and activity of injury; injury types, and body regions affected; and discharge state were compared for assault and self-harm injuries.
Of the 380 patients treated for violence-related injuries, 88.7% were for assault and 11.3% were for self-harm. For both types of injuries, the majority of patients were between the ages of 15 and 44. Assaults frequently occurred in the home, on streets and highways, or in public places; and men (80.4%) were far more likely than women (19.6%) to be treated for this type of injury; a slightly higher proportion of men (55.8%) than women (44.2%) were treated for self-harm, most of which occurred in homes.
Of all injuries treated in the Tîrgu Mures ED, one out of five was violence related. One out of 10 patients that suffered an injury as a consequence of a violent event and treated in the ED required admission to a hospital for further medical care, leading to a significant health care burden. These data suggest that prevention strategies should focus on young adults, and particularly men. Interventions that focus on detection and treatment of psychological illness, reduction of alcohol use and associated aggression, and family and intimate partner violence are suggested as priorities.
To assess the resources for essential and emergency surgical care in the Gambia.
The World Health Organization's Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities - one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities - and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations.
Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway.
The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions.
This study used data from the demographic and health surveys (DHS) conducted between 1999 and 2001 in Benin, Ethiopia, Malawi, Mali, Rwanda, Uganda and Zimbabwe, to examine the magnitude and correlates of conditional acceptance of wife-beating among both men and women. Multivariate logistic regression models were fitted to investigate the independent association between different socio-demographic characteristics and acceptance of wife-beating. The acceptance of wife-beating for transgressing certain gender roles was widespread in all the countries. Men were consistently less likely to justify wife-beating than women. Household wealth and education emerged as strongest and most consistent negative predictors of acceptance of wife-beating among both men and women. Older men and women were less likely to justify wife-beating. Men and women in the polygamous union were more likely to accept wife-beating, though the association was not always significant. With the exception of Uganda, women working for pay were more likely to justify wife-beating than non-working women were. The results indicate that dominant social and cultural norms create images of "ideal" women among both men and women that include definition and widespread acceptance of gender roles as well as sanction use of force to enforce these gender roles. The State and its different institutions may fail to mitigate wife-beating, as sensitivity to objectively address wife-beating may be tellingly lacking. Though education, economic growth, etc, can reduce acceptance of wife-beating, the process may be too slow and too late to make a substantial difference in the near future. Proactive measures may be required to change attitudes towards wife-beating among both men and women.
Head and neck injuries following the road traffic crashes (RTCs) are the most common cause of morbidity and mortality in most developed and developing countries and may also result in temporary or permanent disability.
The aim of this study was to determine the incidence pattern of head and neck injuries, investigate its trend and identify the severity of injuries involved with road traffic crashes (RTCs) during the period 2001-2006.
This is a retrospective descriptive hospital based study.
The patients with head and neck injuries were seen and treated in the Accident and Emergency Department of the Hamad General Hospital and other Trauma Centers of the Hamad Medical Corporation following the road traffic crashes during the period 2001-2006.
This study is a retrospective analysis of 6709 patients attended and treated at the Accident and Emergency and Trauma centers for head and neck injuries over a 6 year period. Head and neck injuries were determined according to the ICD 10 criteria. Of these, 3013 drivers, 2502 passengers, 704 pedestrians and 490 two wheel riders (motor bike and cyclists). Details of all the road traffic crash patients were compiled in the database of the Emergency Medical Services (EMS), and the data of patients with head and neck injuries were extracted from this database.
A total of 6709 patients with head and neck injuries was reported during the study period. Majority of the victims were non-Qataris (68.7%), men (85.9%) and in the age group 20-44 years (68.5%). There were statistical significant differences in relation to age, nationality, gender, and accident during week ends for head and neck injuries (p<0.001). The male to female ratio for head and neck injury was 6.1:1. There was a disproportionately higher incidence of accidents during weekends (27.8%). Majority of the patients had mild injury (87.2%), followed by moderate (7.3%) and severe (5.5%). The highest frequency of head injury was among the young adults 20-44 years (68.5%). There was a remarkable increase in the incidence rate of head and neck injuries per 10,000 population in the year 2005 (18.2) compared to previous years and declined slightly in the year 2006 (17.1). Overall, the incidence of head and neck injuries from road traffic crashes are increasing.
The present study findings provided an overview of head and neck injuries in Qatar from road traffic crashes. The incidence of head and neck injuries is still very high in Qatar, but the severity of injury was mild in most of the victims. The findings of the study highlighted the need for taking urgent steps for safety of people especially drivers and passengers.
Purpose: We sought to: (1) estimate the prevalence of longterm injury-related disability in Ghana; (2) understand the mechanisms of injury causing such disability, with implications for prevention; and (3) understand the anatomic nature of such disability, with implications for treatment. Methods: A household survey was carried out, seeking information on any injury occurring greater than one year ago, from which the injured person had not yet fully recovered. Results: Of 21 105 persons surveyed, 169 reported a long-term injury-related disability, for a prevalence of 0.83% (95% CI 0.67, 1.01%). There was no difference in the prevalence for males vs. females nor for urban vs. rural. Prevalence did increase with increased age. The injury producing events occurred a mean of 6.8 years previously. In the urban area, there was a predominance of transport-related injuries (43%). In the rural area, agricultural injuries predominated (22%), with lesser numbers of transport-related injuries (20%). The anatomic nature of the disabilities included: lower extremity (41%), upper extremity (37%), vision (12%), and miscellaneous (10%). Conclusions: In addition to mortality, long-term disability from injury is a significant problem in this African nation. Based on the mechanisms of injury priorities for injury prevention should be motor vehicle safety in both areas and agricultural safety in the rural area. In terms of injury treatment, the preponderance of injuries was to the extremities. This indicates the potential need to improve orthopaedic care and rehabilitative services.
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